Comment on “Target-Controlled Continuous Infusion for Antibiotic Dosing: Proof-of-Principle in an In-silico Vancomycin Trial in Intensive Care Unit Patients”

Excerpt

We read with great interest the article by Colin and colleagues [1], presenting a proof-of-principle simulation study on target-controlled continuous infusion of vancomycin in intensive care unit (ICU) patients. Vancomycin dosing in critically ill patients poses a particular challenge owing to commonly occurring pathophysiological changes, consequent alterations in pharmacokinetic (PK) processes and the increasing prevalence of bacteria exhibiting antibiotic resistance. To more rapidly achieve therapeutic concentrations and lower the risk of toxicity, continuous-infusion regimens have increasingly been employed. In a clinical trial simulation, Colin et al. compared different dosing strategies for continuous-infusion vancomycin with respect to the probability of achieving effective and potentially toxic concentrations. As a novel dosing approach for vancomycin, adaptive target-controlled infusion (aTCI), also considering data from therapeutic drug monitoring (TDM), resulted superior to conventional dosing strategies, i.e. leading to (1) higher target attainment, (2) faster achievement of defined target concentrations in plasma and (3) lower risk of potentially toxic concentrations. Although these results are impressive, some aspects should be considered when placing the study in clinical context: …